Malnourished in a “Developing” India

In the tiny hamlet of Moregaon in Gadchiroli district in India’s western state of Maharashtra, 29-year-old Durga Bhisa, a tailor’s wife, is busy making local sweetmeats and savories of laddoos, karangis, chaklis and panjiris for her family.

Probe her further for the reasons behind such a scrumptious assortment of snacks, and she chuckles as she recalls, “Two years ago we used to put the powder (supplements) in the water and consume that. It didn’t taste good. We even fed our animals with it. We didn’t know how to use it properly.”

As the middle class continues to grow at a rapid pace with its millennials who earn in six-figures and dream of annual foreign vacations, many like Durga are left to fend for themselves with the “nutritional supplements” the government provides them.

The government’s scheme of Take Home Rations (THR) was introduced in parts like Moregaon, with its measly population of 472. The scheme entails distribution of supplements to pregnant women to boost maternal health, the same supplement that Durga receives once every two months from her aganwadi (community kitchen).

In 2015, Indiaremains one of the highest ranking countries in the world for the number of children suffering from malnutrition. The 2015 Global Hunger Index (GHI) Report(released in October) by the International Food Policy Research Institute ranked India 20th amongst leading countries with a serious hunger situation.

Experts opine that this “national emergency” is to be blamed on government policies. The situation has not changed much even after Indian Prime MinisterNarendra Modi launched a slew of national schemes to uplift the poor as a part of Swavavlamban Abhiyaan (self-reliance drive).

In rural regions, the government’s lopsided developmental policies are the root causes of malnutrition, experts believe. The exploitation of natural resources and minerals, forests and rivers on an industrial scale, has pushed communities into poverty and turned them into ecological refugees and urban migrants. This has had an adverse impact on the vulnerable section of society – women and children.

Source: 2015 GHI

National statistics reveal that six out of every ten women in the country suffer from anemia. The reasons for this are also social and cultural with women traditionally expected to eat only after the men have had their fill. In the majority parts of the country, it is the women who actually take on the bulk of work, at home and in the farms.

Anemic women, in turn, give birth to low birth-weight babies, resulting in a high mortality rate for both infants and mothers. Low birth-weight children comprise 33 per cent of those who are malnourished and stunted. To arrest this cycle, health care workers feel it is vital to address adolescent girls, considering their roles as potential mothers.

In a program being implemented through Community Health Initiative programs in the Parali Primary Health Centre (in Wada Block of Thane District in Maharashtra state) covering a population of 60,000 tribals, measures like counseling, de-worming, hemoglobin (Hb) estimation and iron- and folic-acid supplementation are being undertaken in keeping with the National Rural Health Mission health indicators (to reduce Malnutrition, Infant and Maternal Mortality) since May 2012. Despite these measures, the figures for the malnourished continue to soar.

Environmental degradation has also contributed to the malnutrition problem, especially in tribal belts. Deforestation due to neoliberalisation has resulted in tribals being deprived of forest produce that they were once dependent upon. Whatever small production of crops they used to get earlier from the land has diminished over the years because of undulated agriculture and soil erosion. As the yield is insufficient for over six to eight months, many families migrate as labourers.

Global hunger index evolution

Source: 2015 GHI

However, in some parts of Maharashtra (considered to be a developed state), like Gadchiroli district, the THR schemes faced a major problem because of failure to take into account the prevailing customs and practices, superstition and illiteracy. It was found that pregnant women were choosing to feed their cattle with these supplements rather than consuming the nutritional powder themselves. The women’s complaint was that the powder did not taste good. The challenge was to incorporate the supplements into traditional diet and fare that would make it palatable for the women.

Source: 2015 GHI

Open defecation poses a serious health hazard

In Dumri, 50 km from Ranchi in the eastern Indian state of Jharkhand, 60-year-old Anita Devi, has been defecating in the open for most of her life. She has not only braved the biting cold but has also had a run-in with wild animals. “We have toilets now so we no longer have to deal with death and disease in the village anymore. The government said if our whole village builds toilets, then we will get running water at home. We motivated all the households and even started a village fund for building toilets,” she says.

Whilst attention to diet is just one of the steps taken to combat malnutrition, there are many associated problems and conditions that leave this vulnerable section of women and children prone to diseases and ill health. Abysmal levels of sanitation and the practice of open defecation still prevails in large sections of rural areas. Hygiene and sanitation experts have discovered links between fecal contamination, poor maternal health and resultant malnutrition in children. Bacteria like E.coli spreads through fecal contamination and poses a serious health hazard to women and children.

Launched in 2011, Nirmal Bharat Abhiyan, now known as Swachh Bharat Abhiyan, a national sanitation program, is led by the Panchayat, a local governance body, and aims to eradicate the practice of open defecation by 2017. The scheme is implemented once there is 100 per cent consensus in the village to construct toilets. In order to obtain Open Defecation Free status in villages, officials targeted entire villages vis-à-vis the earlier approach to cover households and found success. A major incentive that works is that ODF villages will be provided with piped water supply.

The Link between Malnutrition and Low Levels of Hygiene

Jharkhand, which has the second highest rate of malnutrition in children (55 per cent) in the country, also tops the charts for anaemia among women, influencing productivity. Health professionals who work in these areas say between four to five per cent of GDP loss has been incurred, annually (approximately Rs 5,000 crore per year in Jharkhand) due to diseases that stem out of unhygienic living conditions.

For health workers, the challenge is to motivate people to adopt standards of hygiene and put their trust in medical science.

“Cleanliness is a big issue for us as people get sick frequently. Villagers are reluctant to go to doctors and visit witch doctors instead. I have to keep on convincing the villagers to do what is best for their health. It’s not easy,” says 45-year-old community worker Makhandi Saharia from Bikhera Dang, Shahbad block of Baran district, 150 km from the nearest city of Kota in the western state of Rajasthan. Between 50 to 60 per cent of deaths of children in the state have been attributed to malnutrition, according to healthcare professionals working in this region.

Stressing on the link between hand washing, disease and malnutrition, the government has promoted the practice of hand washing with soap in states like Jharkhand. People have failed to recognise the link between unsanitary practices, open defecation and diseases such as malaria, jaundice and diarrhea. In addition, frequent illnesses among children leads to lowering their immunity against other illnesses.

The inaccessible village of Bikhera Dang can well serve as a text book example of all the factors and socio economic conditions associated with malnutrition. Levels of hygiene are abysmal, illiteracy abounds and diet is poor due to low-income generation. The indigenous Saharia population here earns its livelihood by gathering Tendu leaves from the forest used in manufacturing beedis. All these factors make for a deadly combination of high rate of malnutrition among the children.

Deforestation in the surrounding hills and rising temperatures have aided in the spread of death and disease in the area. “Pneumonia, diarrhea, malaria, jaundice and high fever is common among children. All this because their immunity is at an all-time low due to poor nutrition choices,” says Makhandi Saharia from her home in Baran district.

Age-old superstitions prevail and mothers seldom reach out to the health centers in time leading to malnutrition deaths. The problem is compounded because Bikhera Dang is 21 km (13 miles) from the nearest main road and has been classified as a hard-to-reach area where medical facilities and supplies are virtually non-existent. “You can see how backward we are,” Makhandi says, pointing at the muddy road that leads to the village.

“Illiteracy and poverty go hand-in-hand. Superstition and refusal to let go of ancient customs have taken a toll on the indigenous Saharias as people don’t avail of medical facilities,” she adds. Her remarks are a succinct reminder of how malnutrition can only be fought by adopting holistic socio-economic policies and by re-defining the parameters of development.